A critical assessment of monitoring practices, patient deterioration, and alarm fatigue on inpatient wards: a review.

Curry JP, Jungquist CR - Patient Saf Surg (2014)

Bottom Line:
Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety.We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment.Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.

ABSTRACTApproximately forty million surgeries take place annually in the United States, many of them requiring overnight or lengthier post operative stays in the over five thousand hospitals that comprise our acute healthcare system. Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety. That bubble burst with the Institute of Medicine's 1999 report: To Err Is Human, followed closely by its 2001 report: Crossing the Quality Chasm. This review article discusses unexpected, potentially lethal respiratory complications known for being difficult to detect early, especially in postoperative patients recovering on hospital general care floors (GCF). We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment. Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.

Mentions:
Since the 1950s, nurses and physicians in training have learned that opioidsproduce death through this singular path involving progressive unidirectionalhypoventilation [30]. The synergy of opioids and a rising PaCO2 contributes tocentral depression of our ventilatory drive, ultimately leading to‘CO2 Narcosis’, an unstable condition that if leftunchecked will lead to respiratory arrest. Opioid associated events aren’tunusual in hospitals today. Experts speculate that up to a third of all codeblue arrests in hospitals could result from opioid induced respiratorydepression [31], and naloxone is administered as an antidote for opioid associatedevents in 0.2-0.7 of patients receiving them postoperatively [32,33]. One estimate has these representing 20,000 of our nation’spatients annually with one tenth suffering significant opioid related injuriesthat include death [34]. These events are always catastrophic, devastating to patients,patient families, and all clinicians involved. Yet in spite of all thisincentive to improve, we have not made meaningful progress in protecting ourpatients from these events for a host of reasons, one major contributor beingthe increased emphasis on optimal postoperative pain management by centers thatgovern reimbursement [6] (Figure 3).

Mentions:
Since the 1950s, nurses and physicians in training have learned that opioidsproduce death through this singular path involving progressive unidirectionalhypoventilation [30]. The synergy of opioids and a rising PaCO2 contributes tocentral depression of our ventilatory drive, ultimately leading to‘CO2 Narcosis’, an unstable condition that if leftunchecked will lead to respiratory arrest. Opioid associated events aren’tunusual in hospitals today. Experts speculate that up to a third of all codeblue arrests in hospitals could result from opioid induced respiratorydepression [31], and naloxone is administered as an antidote for opioid associatedevents in 0.2-0.7 of patients receiving them postoperatively [32,33]. One estimate has these representing 20,000 of our nation’spatients annually with one tenth suffering significant opioid related injuriesthat include death [34]. These events are always catastrophic, devastating to patients,patient families, and all clinicians involved. Yet in spite of all thisincentive to improve, we have not made meaningful progress in protecting ourpatients from these events for a host of reasons, one major contributor beingthe increased emphasis on optimal postoperative pain management by centers thatgovern reimbursement [6] (Figure 3).

Bottom Line:
Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety.We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment.Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.

ABSTRACTApproximately forty million surgeries take place annually in the United States, many of them requiring overnight or lengthier post operative stays in the over five thousand hospitals that comprise our acute healthcare system. Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety. That bubble burst with the Institute of Medicine's 1999 report: To Err Is Human, followed closely by its 2001 report: Crossing the Quality Chasm. This review article discusses unexpected, potentially lethal respiratory complications known for being difficult to detect early, especially in postoperative patients recovering on hospital general care floors (GCF). We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment. Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.